For many dentists, it is more than annoying: the benefit statement. Instead of concentrating fully on their patients, they often spend several hours a week on administrative tasks, a large part of which on invoicing. There are a few things to consider — in particular the differences between private medical billing according to GOZ and contract dental billing according to BEMA.
This is how private dental billing according to GOZ works
In Germany, private dental services are billed on the basis of GOZ. This regulates which dental services can be provided and invoiced outside of statutory health insurance.
The GOZ defines both the treatment options as well as the corresponding feesthat are required for this.
Dentists who treat private patients or self-payers must therefore comply with these requirements in order to ensure transparent and correct billing.
For most dental services, the GOZ has a fixed fee number , which serves as a basis for calculating the fee. Detailed information to patients about the costs before starting treatment is also required to avoid misunderstandings.
These services are listed in the GOZ
The GOZ is very extensive and includes a variety of dental services, which are divided into different categories:
- Diagnostic services: Oral examination, diagnosis and consultations.
- Prophylaxis and preventive measures: Preventive measures, such as professional teeth cleaning (PZR).
- Conservation services: Filling therapies for tooth decay, root canal treatment and gum treatment.
- Surgical services: Extractions, root tip resections or the placement of implants.
- Prosthetic care: The manufacture and adjustment of crowns, bridges or prostheses.
- orthodontic treatments: Measures to correct misaligned teeth, such as the use of braces.
How to calculate your fee according to GOZ
Billing according to GOZ is based on a Points system, with each achievement having a fixed point value. This point value is multiplied by an amount in euros to calculate the fee.
The current score is 5.62421 cents.
For each performance, you can also use a Boosting factor be set between 1.0 and 3.5, depending on the level of difficulty and the cost of the treatment. The standard is a 2.3-fold increase factor. In order to increase the increase factor, the dentist must justify this in writing.
Example of a fee calculation
Assume that a dental service has 80 points and the standard increase factor of 2.3 is used:
80 points × 5.62421 cents × 2.3 = 10.35€
If a more complex treatment is carried out, the increase factor can be increased to 3.0, for example:
80 points × 5.62421 cents × 3.0 = 13.49€
Individual health services
In addition to the point value and the increase factor, individual health services (iGEL), which are not listed in the GOZ, are billed separately. These services must be discussed with the patient in advance and agreed in writing.
This is how health insurance billing for dentists according to BEMA works
Statutory insured persons are billed in accordance with Assessment standard for dental services (BEMA). This fee schedule determines which services dentists may provide under statutory health insurance and which costs are covered by health insurance companies.
In contrast to the GOZ, where dentists are free to choose and structure the fee figures, benefits in BEMA are more strictly regulated and specified.
To note: Many additional dental services that go beyond the scope of BEMA are billed in accordance with GOZ.
These services are listed in BEMA
Similar to the GOZ, BEMA also lists the various services that dentists are allowed to provide for legally insured patients. These benefits are also divided into categories:
- Diagnostic services: Initial examinations, diagnoses and X-rays.
- prophylaxis: Basic measures for tooth preservation, such as fissure sealing.
- Conservation services: Standard fillings and root canals.
- Surgical services: Tooth extractions or minor operations in the mouth.
- Prosthetic care: Standard dentures, such as bridges or prostheses.
- orthodontics: Treatment of malpositions in children and adolescents.
Good to know: The benefits that can be billed through statutory health insurance are often limited to specific materials or techniques that are considered “appropriate and sufficient.”
How to calculate your fee according to BEMA
Billing in accordance with BEMA is also based on a points system. Each performance in BEMA has a fixed point value, which is determined by the Compensation rate health insurance companies are multiplied.
These compensation rates may vary from fund to fund and are subject to regular adjustments.
A major difference with GOZ is that the increase factor in BEMA billing is also not freely selectable. All services are remunerated at a fixed rate, unless there are special exceptional cases that require additional permits.
BEMA statement example
Assume that filling therapy has a score of 80 points in BEMA and the health insurance payment rate is 0.90 cents:
80 points × 0.90 cents = €72.00
The calculation is therefore much clearer and less flexible than with GOZ.
Optimize dentist billing: How to reduce your effort
To reduce billing costs in your practice, we recommend: Use digital billing services such as Nelly to efficiently optimize your billing processes and relieve your team.
Nelly helps you with billing for private patients (GOZ), legally insured persons (BEMA) and self-payers. Nelly's KZV factoring makes billing with health insurance companies easier, as the service provider handles invoicing and payment directly.
What's special about Nelly?
Different from traditional factoring services Nelly offers a purely digital solution, which saves you and your team both time and money — for example by eliminating postage and printing costs. Another advantage: Liquidity bottlenecks are avoided as payouts are made directly.
Nelly is particularly ideal for new practice start-ups, as no start-up capital is required and at the same time strengthens your creditworthiness. Your practice remains financially flexible and liquid, which not only gives you planning security, but also more freedom in organizing your practice.
Dental services made easy with Nelly
With Nelly's innovative technology, the billing of dental services for private patients, self-payers and health insurance patients is completely automated. You can enter all important data, such as the payment method, easily and quickly — even directly via your patients' smartphones.
Another key advantage: The immediate payout via Nelly Factoring makes your practice immediately liquid without having to wait for the quarterly statement from health insurance companies. This saves time, avoids liquidity bottlenecks and significantly reduces the need for loans.
Gladly We will advise you free of charge and without obligation to a solution that is tailored to your practice.
Contact us now for more information!
Common questions
How does billing work at the dentist?
Depending on the type of patient, the dentist is billed via BEMA (for legally insured persons) or GOZ (for private patients). The dentist issues an invoice to the patient, which he can submit himself to health insurance or supplementary dental insurance. Material and laboratory costs are often billed separately.
How does direct billing at the dentist work?
With direct billing, the dentist settles the costs directly with health insurance or private insurance. The patient does not have to make advance payments. This is rare among legally insured persons and is usually limited to certain special cases, while it is more common among private patients with special agreements or supplementary insurance.
What is the maximum fee schedule for dentists?
The maximum rate of the fee schedule for dentists (GOZ) is 3.5 times set. This can be used in special cases when treatment is particularly difficult, time-consuming or complex. A written explanation is usually required, and an additional agreement may be made in the case of private patients.
What is external billing for dentists?
With external billing, dentists hand over their billing processes to specialized billing services, which take over the billing of GOZ and BEMA services in order to reduce administrative costs
How exactly does GOZ billing work for dentists?
The GOZ statement is based on the schedule of fees for dentists, which applies to private patients. Depending on the effort and complexity, services are billed at different rates.
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